BLOOD VESSEL PATHOLOGY Flashcards
most imp risk factor for DVT
prolonged immobilization
Primary or secondary Raynaud?
- exaggerated central and local vasomotor responses to cold or emotion
- Young women
- symmetrically affect the extremities
- Static extent & severity
Primary Raynaud phneomenon
1. Identify the lesion described:
a. calcification of the walls of muscular arteries, typically involving the internal elastic membrane
b. do not encroach on the vessel lumen
c. not clinically significant.
2. Radiographic pattern?
- Mönckeberg medial calcific sclerosis
- Pipestem appearance
homogeneous, pink hyaline thickening with associated luminal narrowing
Hyaline arteriolosclerosis
•Necrotizing granulomas of URT/LRT & Kidneys +Necrotizing granulomatous vasculitis of small/medium vessels esp lungs & upper airways
- PR3-ANCAs -up to 95% of cases
- •sinusitis / mucosal ulcerations of the nasopharynx
- bilateral nodular and cavitary infiltrates
Wegner granulomatosis (Granulomatosis with Polyangiitis)
Identify the vasculitis:
- •Main arteries affected- temporal, vertebral, ophthalmic
- Age >50
- Microscopy: medial granulomatous inflammation centered on the internal elastic lamina
- •Increased ESR , sometimes exceeding 100mm/1st hour
- Assoc with polymyalgia rheumatica
Giant Cell (Temporal) Arteritis
Most common cause of thoracic aortic aneurysms
Hypertension
Identify the lesion described:
•malignant endothelial neoplasm
- Develops in the ipsilateral upper extremity several years after radical mastectomy
Lymphangiosarcoma
Identify the lesion described:
frequency increases with age, does not regress.
Microscopy shows thin-walled capillaries with scant
stroma
Cherry hemangioma
3 conditions assoc with hyaline arteriolosclerosis
- hypertension
- diabetic microangiopathy
- Nephrosclerosis
Identify the lesion described:
assoc with Turner Syndrome
Indistinct margins, unencapsulated
massively dilated lymphatic spaces lined by endothelial cells and separated by intervening connective tissue stroma containing lymphoid aggregates.
Cystic Hygroma (Cavernous Lymphangioma)
•conjunctival and oral erythema
- •desquamative rash of palms and soles
- Coronary artery aneurysm
- Strawberry Tongue
- Hand and feet edema
- less than 4 years old
Kawasaki Disease (MUCO CUTANEOUS LYMPH NODE SYNDROME)
Is this a Vulnerable/ Stable plaque?
- Thin fibrous cap
- Large lipid core
- Intense inflammation
Vulnerable
Identify this condition:
Assoc with hyperestrogenic states
radial,pulsatile arrays of dilated subcutaneous arteries/arterioles bout a central core
blanch with pressure
Spider telangiectasia
Why do we get onion skinning in malignant hypertension- what do those laminations represent?
Laminations consist of smooth muscle cells with thickened, reduplicated basement membrane
What is the downstream effect of fibromuscular dysplasia?
Can cause renal artery stenosis which in turn leads to secondary hypertension
In a hypertensive with activation of the RAA axis, where will the levels of Angiotensin II be highest?
Pulmonary artery or pulmonary veins?
Pulmonary veins - as ACE is produced primarily within the endothelial cells of small pulmonary vessels
Identify the lesion described:
- malignant endothelial neoplasm
- older adults
Assoc with exposure to Thorotrast/arsenic/polyvinyl chloride
plump, atypical endothelial cells forming vascular channels
Hepatic angiosarcoma
Identify this lesion:
assoc with von Hippel Lindau disease
large, cavernous blood-filled vascular spaces separated by connective tissue stroma
Cavernous hemangioma
small-vessel
MPO-ANCAs
Classically associated with asthma, allergic rhinitis, lung infiltrates, peripheral hypereosinophilia
Multisystem involvement
extravascular necrotizing granulomas
Churg - Strauss Syndrome aka allergic granulomatosis and angiitis
- What is the gross appearance called?
- Secondary to which infection?
- Which layer of the vessel is affected?
- Tree barking
- Syphilis
- Vasa Vasorum
- Identify the lesion described below:
Young woman of child bearing age
Histopathologic examination of the renal arteries exhibit collagenized tunica media alternating with regions of thinned media
Angiogram image attached
- What’s the classic pattern seen on angiogram called?
- Fibromuscular dysplasia
- Beading
Primary or secondary Raynaud?
- vascular insufficiency due to arterial disease caused by other entities
- Eg: SLE, scleroderma, Buerger disease, atherosclerosis.
- asymmetric involvement of the extremities
- Worsens in extent & severity over time
Secondary Raynaud phenomenon
Secondary hypertension that occurs secondary to renovascular disease such as atherosclerosis or fibromuscular dysplasia is an example of high renin or low renin hypertension?
High renin hypertension
Mechanism of varicose veins development
prolonged, increased intraluminal pressure leads to
vessel dilation and incompetence of the venous valves which in turn leads to stasis, congestion, edema, pain, and thrombosis
One term that describes the following: systolic pressure more than 200 mm Hg, diastolic pressure more than 120 mm Hg), renal failure, and retinal hemorrhages and exudates, with or without papilledema
Malignant hypertension
SVC/IVC compression syndrome?
- Marked dilation of the veins of the head, neck, and arms with cyanosis
- Respiratory distress
SVC syndrome
Typically occurs secondary to a bronchogenic carcinoma
Substance whose production drives intimal smooth muscle cell proliferation
PDGF
1. Identify the lesion described:
a. Initiates with an intimal tear
b. CXR shows mediastinal widening
c. See attached CT/MRI
2. List 2 radiographic features seen in the attached image
- Aortic dissection
- a. intimal flap, b. double barrel lumen
Heavy cigarette smokers
luminal thrombosis with microabscesses
intermittent claudication
gangrene
Thromboangiitis Obliterans (Buerger Disease)
Identify this vascular tumor from the features described:
grow during childhood
do not fade/regress with time
assoc with Sturge Weber Syndrome
Port wine stain
Identify the vasculitis described below:
• Known association in 30% with chronic hepatitis B
- medium vessel involvement
•Vessels at various stages of acute & chronic inflammation; segmental transmural necrotizing inflammation
Acute stages may show fibrinoid necrosis
Polyarteritis nodosa (PAN)
most common site for traumatic aortic rupture
aortic isthmus
2 important risk factors for aortic dissection
- Hypertension
- inherited or acquired connective tissue disorders with defective vascular extracellular matrix
Major cause of abdominal aortic aneurysms
atherosclerosis
Complications of the lesion seen in the image
The lesion is Varicose veins.
The complications are:
- Stasis dermatitis
- Ulcerations
- Poor wound healing
- Superimposed infections
- What does this gross image represent?
- What is this composed of?
- Fatty streak
- lipid-filled foamy macrophages.
- What finding does this gross lesion represent?
- What is this lesion composed of?
- Atherosclerotic plaque
- intimal thickening + lipid accumulation
Identify the lesion described
- follows viral upper respiratory infection, group A streptococcal pharyngeal infection
- IgA–anti-IgA immunocomplex (type III hypersensitivity disease)
- Kidneys- hematuria, glomerulonephritis
- GIT- colicky abdominal pain and vomiting, melena
Immunoglobulin A vasculitis (Henoch Schoenlein Purpura)
What finding does this image represent?
Hyperplastic arteriolosclerosis (onion-skinning)
What is an additional finding seen in malignant hypertension apart from onion-skinning?
Fibrinoid necrosis
- What lesion does this image represent?
- What causes this lesion?
- cystic medial degeneration
- Medial wall ischemia
•Leukocytoclastic vasculitis
. All lesions tend to be of same age
Microscopic Polyangiitis
Identify the vasculitis described below:
- Microscopic features-granulomatous vasculitis of medium and larger arteries
- Predilection: aortic arch & great vessls
- Less than 50 years
- Young females, Asia
- marked weakening to absence of the pulses in the upper extremities
Takayasu Arteritis(pulseless disease)
Enumerate the possible Pathologic changes in an atheromatous plaque
- Rupture, ulceration or erosion of the plaque surface
- Thrombosis
- Hemorrhage into a plaque
- Atheroembolism
5Aneurysm formation
most frequent pre-existing histologically detectable lesion in aortic dissection
cystic medial degeneration
most common serious clinical complication of DVT
Pulmonary embolism
What finding does this image represent?
Atherosclerotic plaque with a thrombus occluding the lumen
Morphology: red purple macules- nodules- plaques
assoc with HHV -8
sheets of plump proliferating spindle cells
commonly seen in immunocompromised
Kaposi Sarcoma
- Clinical presentation of aortic dissection
- Which valvular heart lesion can develop secondary to aortic dissection?
- Sudden onset of excruciating pain, usually beginning in the anterior chest, radiating to the back between the scapulae
- Aortic regurgitation
Initial trigger event in the pathogenesis of atherosclerosis
Chronic endothelial injury and dysfunction
Name a condition where the following microscopic vessel finding is encountered:
•concentric, laminated (“onion-skin”) thickening of the walls with luminal narrowing
Severe hypertension
See attached image.
What is the function of the cells that this tumor originates from?
The image shows a glomus tumor.
It originates from glomus bodies.
Function: Temperature regulation
Levels of this cytokine correlate with severity of giant cell arteritis
IL-6
Drug used for treatment of Giant cell arteritis
Tocilizumab (anti IL-6)
Newborn infant, reddish lesion on the buttocks, benign, requires watchful waiting and reassurance to parents
Juvenile hemangioma also known as strawberry hemangioma
cause for reddish brown discoloration in stasis dermatitis
Deposition of hemosiderin
